MEDICARE: SOLOMON LAKTINEH, M.D. A MEDICAL CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	A50421	CA

General Provider Information

NPI Number	:	1093068330
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOLOMON LAKTINEH, M.D. A MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	1040 ELM AVE SUITE 304
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90813-3267
Country	:	US
Telephone Number	:	562-624-1111
Fax Number	:	562-624-1115

Provider Business Practice Location Address
First Line	:	6624 CHERRY AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90805-1715
Country	:	US
Telephone Number	:	562-630-2200
Fax Number	:	562-630-2209

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SOLOMON LAKTINEH
Credential	:	M.D.
Telephone Number	:	562-624-1111

Provider Enumeration Date	:	10/24/2012
Last Update Date	:	10/24/2012

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